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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494507
Report Date: 09/30/2024
Date Signed: 09/30/2024 12:46:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2024 and conducted by Evaluator Tatiana Bickham
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20240923085257
FACILITY NAME:INTIWASI EARLY EDUCATION CENTERFACILITY NUMBER:
197494507
ADMINISTRATOR:ARACELI GUZMANFACILITY TYPE:
850
ADDRESS:9017 W. PICO BLVDTELEPHONE:
(424) 527-0096
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:63CENSUS: 34DATE:
09/30/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Ilce Alvarez FrancoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not have required immunization's.
Children do not have required vaccinations
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Tatiana Bickham and Amelia Morales conducted an unannounced complaint inspection on 09/20/2024 at 09:10 AM. LPAs met with Director Ilce Alvarez Franco to discuss the above allegations. At the time of arrival LPAs observed 34 children in care with 6 staff.

During today's inspection LPAs Bickham and Morales toured the facility, interviewed the director, staff, collected children's and staff rosters. LPAs also reviewed children and staff files.

Per reporting party staff and children do not have the required immunization's.

At 9:48 AM LPAs condcuted file review. During the file review for children's immunization records out of the 37 files that were reviewed, 6 children were missing proof of immunization's.
Page 1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 58-CC-20240923085257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: INTIWASI EARLY EDUCATION CENTER
FACILITY NUMBER: 197494507
VISIT DATE: 09/30/2024
NARRATIVE
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At 10:05 AM while reviewing staff records, 2 out of 7 staff are missing proof of immunization's. 7 out of 7 staff are missing current influenza vaccine or declination.

Based on the LPAs observations, and interview concluded with Director the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22 (code) is being cited on the attached LIC 9099D.

Exit interview was conducted with Director Ilce Alvarez Franco. Appeals Rights and the Notice of Site visit were provided. The Notice of Site Visit must remain posted for 30 days during the hours of operation. Failure to maintain posting as required will result in a civil penalty of $100.00.



Page 2.
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 58-CC-20240923085257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: INTIWASI EARLY EDUCATION CENTER
FACILITY NUMBER: 197494507
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2024
Section Cited
CCR
101220.1(a)
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(a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.

This requirement is not met as evidence by:
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Director will email proof of vaccination records to LPAs by 10/10/2024
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Based on LPAs observation and recored review, Director did not ensure all children had proof of vaccination prior to admission.
This poses a potential health, safety, or personal rights risk to the children in care.
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Type B
10/10/2024
Section Cited
HSC
1596.7995(a)(1)
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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Director will email proof of vaccination records to LPAs by 10/10/2024
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This requirement is not met as evidence by:

Based on LPAs observation and recored review director did not ensure all staff has proof of vaccination prior to employment.
This poses a potential health, safety, or personal rights risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Tatiana Bickham
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5